Biomechanical and Histological Study of Retrieved LARS Synthetic Ligaments.

Background: Synthetic grafts have been used for a number of years in anterior cruciate ligament (ACL) reconstruction surgery. One of the more recent additions to the stable of synthetic ligaments is the Ligament Augmentation and Reconstruction System (LARS) ligament.

Purpose: To analyze the biomechanics and histology of LARS grafts retrieved due to failure of the device.

Transphyseal ACL reconstruction and tenodesis in skeletally immature patients demonstrates encouraging clinical scores, without growth disturbance, excessive laxity or re-injury.

Purpose: Paediatric patients demonstrate high re-rupture rates after anterior cruciate ligament reconstruction (ACLR), with numerous surgical techniques proposed to deal with this challenging cohort. This study investigated the early clinical outcomes, complications, return to sport (RTS) and re-rupture rates up until 2-years post-surgery in paediatric patients presenting with open growth plates undergoing transphyseal ACLR that was combined with an extra-articular tenodesis (LET).

Methods: Between October 2017 and September 2020, 20 skeletally immature patients were consecutively recruited and underwent transphyseal ACLR and LET.

Development and application of a proximal hamstring MRI-based scoring tool in patients undergoing proximal hamstring tendon surgical repair.

Purpose: An MRI-based scoring tool assessing surgical repair after proximal hamstring avulsions may provide benefit in the context of research, while serial post-operative MRI will provide insight of what to expect in the clinical context of early re-injury requiring imaging. This study developed and assessed the reliability of a Proximal Hamstring Objective Magnetic Resonance Imaging Score (PHOMRIS), further assessing MRI-based repair status and its correlation with patient-reported outcome.

Methods: 15 patients that underwent proximal hamstring surgical repair underwent MRI and clinical review pre-operatively and at 3-, 6- and 12-months.

Surgical treatment of high-grade acute intramuscular hamstring tendon injuries in athletes leads to predictable return to sports and no re-injuries.

Purpose: The purpose of this study was to assess the post-operative return to sport and re-injury rates following surgical repair of acute, first-time, high-grade intramuscular hamstring tendon injuries in high level athletes.

Methods: Patients were identified using the databases of two sports surgeons. Once patients were identified their clinical notes and imaging were reviewed to confirm that all patients had injuries to the intramuscular portion of the distal aspect of the proximal biceps femoris tendon.

Good clinical scores, no evidence of excessive anterior tibial translation, a high return to sport rate and a low re-injury rate is observed following anterior cruciate ligament reconstruction using autologous hamstrings augmented with suture tape.

Introduction: Augmented anterior cruciate ligament reconstruction (ACLR) techniques have been proposed to reduce the high reported re-injury rates and low rates of return to sport (RTS). This study reports clinical outcomes, RTS and re-injury rates in patients undergoing ACLR using autologous hamstrings augmented with suture tape.

Materials And Methods: A total of 53 patients were prospectively recruited, undergoing ACLR using hamstrings with suture tape augmentation, combined with a structured rehabilitation programme.

The role of hospitals in strengthening primary health care in the Western Pacific.

Despite the imperative to strengthen primary health care (PHC) to respond to demographic and epistemological transitions, and meet commitments to achieve universal health coverage, health systems remain hospital-centric with health resources largely concentrated in urban centres. This paper examines islands of innovation that demonstrate the role hospitals can play in influencing the provision of PHC. Drawing on the literature and country case studies from the Western Pacific region, we illustrate mechanisms used to unlock hospital resources to improve PHC, with the transition towards "systems-focused hospitals".

Using health policy and systems research to influence national health policies: lessons from Mexico, Cambodia and Ghana.

Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy.

A structured accelerated versus control rehabilitation pathway after anterior cruciate ligament reconstruction using autologous hamstrings demonstrates earlier improvement in physical outcomes without increasing graft laxity: A randomized controlled trial.

Objectives: To investigate whether an accelerated rehabilitation pathway could enhance strength and functional symmetry after ACLR, without affecting laxity.

Design: Randomized Controlled Trial.

Setting: Private rehabilitation clinic.

Selective bundle reconstruction for symptomatic partial anterior cruciate ligament tears demonstrates good functional scores, high return to sport rates and a low re-tear rate.

Background: The treatment of symptomatic partial anterior cruciate ligament (ACL) tears remains controversial. This study investigated the clinical and functional outcome of patients undergoing selective posterolateral (PLB) or anteromedial (AMB) bundle reconstruction.

Methods: 55 consecutive patients underwent partial bundle reconstruction, of which 45 (AMB = 17, PLB = 28) were included in the current analysis (62% male, mean age of 29.

Role of regulatory capacity in the animal and human health systems in driving response to zoonotic disease outbreaks in the the Mekong region.

We conducted a policy situation analysis in three Mekong region countries, focused on how the animal and human health systems interact to control avian influenza (AI). The study used scoping literature reviews aimed at establishing existing knowledge concerning the regulatory context. We then conducted a series of key informant interviews with national and sub-national government officials and representatives of producers and poultry farmers to understand their realities in managing the complex interface of the two sectors to control AI.

Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis.

Purpose: To compare the clinical and radiological outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with, or without, LARS augmentation.

Methods: One-hundred and thirty-six patients that underwent double-bundle ACLR with (DB Hams/LARS, n = 67), or without (DB Hams, n = 69), LARS augmentation, were assessed clinically and with Magnetic Resonance Imaging (MRI) at a minimum of 7-years post-surgery. Patients were assessed via patient-reported outcome measures (PROMs), KT-1000 (laxity), isokinetic knee extensor and flexor strength and a 4-hop test battery.

Anterior Cruciate Ligament Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Versus Hamstrings Alone: A Comparative Cohort Study.

Background: Few studies have reported the return-to-sports (RTS) rate in patients after augmentation of autologous anterior cruciate ligament reconstruction (ACLR) with the Ligament Augmentation and Reconstruction System (LARS).

Purpose/hypothesis: The purpose of this study was to compare postoperative outcomes in patients who underwent ACLR with single-bundle 4-strand hamstring autograft either without augmentation (HA-ACLR group) or with LARS augmentation (AUG-ACLR group). It was hypothesized that clinical outcomes and RTS rates would be better in the AUG-ACLR group at the 1-year follow-up, with similar outcomes in both cohorts by 2 years.

Isokinetic torque analysis demonstrates deficits in knee flexor and extensor torque in patients at 9-12 months after anterior cruciate ligament reconstruction, despite peak torque symmetry.

Background: Lower limb strength asymmetry is associated with re-injury after anterior cruciate ligament reconstruction (ACLR). This study investigated limb symmetry indices (LSIs) during isokinetic knee extensor and flexor assessment after ACLR.

Methods: Overall, 25 patients underwent isokinetic knee extensor and flexor strength assessment, 9-12 months after ACLR with a semitendinosus autograft.

The long-run effects of noncommunicable disease shocks.

The health shocks literature typically does not take into account the temporal patterns of loss since the time of the shock. This limits understanding of the long-run impact of health shocks and the capacity of individuals to cope over time. This study estimates the dynamic effects of a noncommunicable disease shock on the economic well-being of working-age individuals in China up to 6 years after onset.

Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years.

Background: Anterior cruciate ligament reconstruction (ACLR) has a high incidence of re-tear in younger patients. Despite comparable functional outcomes, the incidence of re-tear using single and double bundle ACLR methods has not been well reported.

Aim: To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.

Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013.

Introduction: Cambodia's health equity fund (HEF) is the country's most significant social security scheme, covering the poorest one-fifth of the national population. During the last two decades, the HEF system was scaled up from an initial two health districts to national coverage of public health facilities. This is the first national study to examine the impact of the HEF on the utilisation of public health facilities.

Current Perspectives of the Australian Knee Society on Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction.

Context: The importance of rehabilitation and evaluation prior to return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction has been reported.

Objective: This study sought to investigate current perspectives of Australian orthopedic surgeons on rehabilitation and RTS evaluation.

Design: Survey.

ACL Reconstruction Using Autologous Hamstrings Augmented With the Ligament Augmentation and Reconstruction System Provides Good Clinical Scores, High Levels of Satisfaction and Return to Sport, and a Low Retear Rate at 2 Years.

Background: There are a number of surgical methods for undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although relatively high rates of ipsilateral retears and contralateral tears exist, with only 65% of patients returning to their preinjury level of sport. ACLR techniques adopting synthetic augmentation have been proposed in an attempt to improve clinical outcomes and reduce reinjury rates.

Purpose: To determine the efficacy of ACLR using autologous hamstrings augmented with the Ligament Augmentation and Reconstruction System (LARS).

Arthroscopic assessment of patella tracking correlates with recurrent patellar instability.

Purpose: For recurrent lateral patellar instability surgical algorithm, an arthroscopic assessment of patellar tracking can aid with the decision of adding a tibial tubercle transfer procedure based on knee flexion angle at which patella centrally engages in its groove. Tibial tubercle-trochlear groove distance is variable in normal values and has discrepancies between imaging modalities. The aims of our study were to assess correlation of arthroscopic patellar tracking technique with recurrent patellar instability, and to assess the accuracy and reproducibility of this technique.

What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies.

Background: All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance.

Reconstruction of chronic proximal hamstring avulsion injuries using ipsilateral distal hamstring tendons results in good clinical outcomes and patient satisfaction.

Purpose: To report outcomes following proximal hamstring reconstruction employing an ipsilateral distal hamstring tendon autograft, in patients with chronic proximal ruptures.

Methods: Six patients presenting with a chronic proximal hamstring avulsion and a medial time from injury of 11.0 months (range 7-18), confirmed via magnetic resonance imaging, underwent proximal hamstring repair using a free graft harvested from the ipsilateral distal hamstrings.

The impact of ASEAN economic integration on health worker mobility: a scoping review of the literature.

The Association of Southeast Asian Nations (ASEAN) Economic Community (AEC) was inaugurated in December 2015 with the primary aim of achieving a strong and prosperous community through accelerating economic integration. The notion of a single market, underpinned by the free flow of trade in services and skilled labour, is integral to the spirit of the AEC. To facilitate the intra-regional mobility of health professionals, Mutual Recognition Arrangements (MRAs) were signed, for nursing in 2006 and for medicine and dentistry in 2009, and now sit within the AEC objectives.

Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation.

Background: Preventing and mitigating the risk of reinjury after anterior cruciate ligament reconstruction (ACLR) rest on variables including age, surgical restoration of knee stability, adequate physical function, and thorough and complete postoperative rehabilitation, but to what degree these factors influence return to sport is unclear.

Purpose: To investigate factors predictive of return to sport 12 months after ACLR. The factors specifically evaluated were strength, hop function, self-reported knee function, patient age, and quality of postoperative rehabilitation.

No clinical difference in 10-year outcomes between standard and minimal graft debridement techniques in patients undergoing anterior cruciate ligament reconstruction using autologous hamstrings: a randomized controlled trial.

Purpose: Delayed ligamentization following anterior cruciate ligament reconstruction (ACLR) may result in reduced graft stiffness and strength, and an increased risk of secondary re-tear. Remnant sparing ACLR may accelerate ligamentization and proprioceptive function, theoretically reducing re-injury risk. This study sought to investigate 10-year graft failure rates and patient perceived knee functioning in those undergoing ACLR with remnant preservation (RP), versus remnant debridement (RD).